BARRIER NURSING

The term "barrier nursing" is given to a method of nursing care that has been used for over one hundred years when caring for a patient known or thought to be suffering from a contagious disease such as open pulmonary tuberculosis. It is sometimes called "bedside isolation." As the name implies, the aim is to erect a barrier to the passage of infectious pathogenic organisms between the contagious patient and other patients and staff in the hospital, and thence to the outside world. Preferably, all contagious patients are isolated in separate rooms, but when such patients must be nursed in a ward with others, screens are placed around the bed or beds they occupy. The nurses wear gowns, masks, and sometimes rubber gloves, and they observe strict rules that minimize the risk of passing on infectious agents. All equipment and utensils used to care for the patient are immediately placed in a bowl of sterilizing solution, and attending nurses observe surgical standards of cleanliness in hand washing after they have been attending the patient. Bedding is carefully moved in order to minimize the transmission of airborne particles, such as dust or droplets that could carry contagious material, and is cleansed in special facilities that include the use of steam heat for sterilization.

Barrier nursing often failed its objective, especially in hospital wards of the traditional "Nightingale" pattern, with rows of beds lined up on two or more sides of a large room. Airborne and droplet infection all too frequently penetrated the imperfect barrier, and sometimes even fecal-oral infectious agents found ways to invade the imperfect protective measures intended to block their passage. Late in the twentieth century, barrier nursing was superceded by more effective and more rigorous universal precautions.